Archive for January, 2010

“I always seem to have the supplies I do not need. I always seem to be missing the supplies I do need. Quite a balancing act is required to meet the needs of my patient.”

“I am away from the bedside looking for supplies.”

These were the comments I heard from staff even though we have a hardworking group in Procurement Services and order many supplies each week. So why does there seem to be waste … in too much inventory and too much time spent looking for the right item to provide patient care?

Recently, I was given a unique opportunity to work with the first Rapid Improvement Event (RIE) team to improve care at the bedside. The entire week was spent working in the McLeod Tower on 5 East and in the McLeod Pavilion on the 9th Floor. We worked with the staff on each unit to reduce the time spent hunting and selecting supplies involved with patient care. One aim was to reduce the number of times a caregiver leaves the patient care area to retrieve supplies.

This RIE was the first of twenty-four (24) RIEs to provide better methods, better solutions, and better care for our patients. With so many things vying for our attention, it is difficult to focus on administering the best care for each patient. So we want to cut through the chaos, simplify and stay focused on what is best for the patient.

One of our measurements at the beginning of the week was the number of times a caregiver leaves the pod or patient room assignment to find, scan, carry and gather the needed supplies for patient care. On average, a caregiver left their area 17 times per shift. We mapped and measured the distance for each step, each supply. We did not focus on forms or medications this week, as those will be improved in a separate RIE in the future.

Working together through several solutions, we used the PDCA cycle of: P – Planning a solution; D – Do, actually go out and experiment; C – Check, verify if the solution worked or needs modification; and A – Act, integrate the lessons learned from our check. Measure all along the way and try again. By the end of the week, we had reduced the seventeen trips for supplies to four trips per shift. As of today, the gains are holding and we will look for ways to ’spread’ this solution to each nursing unit in both the McLeod Pavilion and the McLeod Tower. In addition, we are piloting a different Omnicell solution on 9th floor, which will improve the current pause or delay in scanning supplies. (Note: The PDCA cycle is a never-ending cycle of learning and improvement utilized by Dr. Edward Deming, based on what he learned from his mentor, Walter Shewhart. Dr. Deming taught this cycle of improvement to the Japanese in 1950. He called it the “Shewhart cycle” and many today call it the Deming wheel since the steps in the PDCA are continuous).

In the future, I will give more details about the other RIE teams working on patient flow and rapid response. It was a exciting week. I learned a great deal from the staff on the team and in the nursing units. I remain convinced that Operational Effectiveness will help us solve our process problems and remove wasted steps and barriers in our work.

Thank you for your interest in supporting the relief efforts in Haiti. We have all been very concerned about the well being of the people in that area which has truly been devastated by the recent earthquake. Many of you within the McLeod family have expressed a desire to help and we are currently watching rescue and recovery very closely in preparation for our organization’s response.

A team has been formed to evaluate the current needs, which are medical help, medical supplies, food, water and money and to determine how McLeod can be most effective in providing outreach and assistance.

Distribution, transportation and safety seem to be the greatest current obstacles to relief in Haiti. We will be forming a plan to help and extend support in the weeks ahead. If you are interested in being a part of this work or are currently part of a medical mission team and can provide insight to our planning, please contact: Haiti.Relief@McLeodHealth.org.

On Wednesday, I attended our Department Directors Meeting. The meeting is at 9:30 a.m. in Florence for leaders in Florence and Darlington, and at 1:00 p.m. for leaders in Dillon. The meeting is held twice each month in order to recognize, congratulate and educate. The morning meeting began with the recognition of Merit Award recipients.

Tammy White

Beth Caldwell

As you know, Merit Award recipients are recognized by the team for demonstrating the McLeod values of Caring, Person, Quality and Integrity. This honor comes from one’s peers and represents a high standard of individual achievement, demonstrated by a positive caring attitude, professionalism and service.

About 47 of our 4,700 workforce receive this recognition during the year. They are among the top one to two percent of our workforce and are examples to each of us and our community of cheerful and compassionate service given to the welfare of others. This week, recognition was given to Tammy White, a member of the Public Information Office, and Beth Caldwell, a member of the team in the Laboratory. It was a great time to hear from their Directors about why members of the team nominated them and why the Merit Award Committee recommended Tammy and Beth for this honor. We had a chance to hear the details of how Tammy and Beth serve and what others think about how they teach our values by their actions.

Please join me in congratulating Tammy and Beth, as well as all our other Merit Award recipients in the organization.

On Thursday I attended our weekly Planning meeting. The master facility plans for all service lines are maintained and updated in this meeting. One of the agenda items was a review of the final plans for a new Emergency Department in Dillon.

As the sole provider of emergency services in Dillon, there is a great demand for ED services. In 2006, the McLeod Dillon Emergency Department treated nearly 24,000 patients while two years later there were 26,760 visits.

Responding to meet the growing needs of emergency care in Dillon, plans are underway for renovations and construction of a new Emergency Department at McLeod Dillon. The addition will be constructed on the existing Dillon campus located at the intersection of Highway 301 and Jackson Street. A Certificate of Need has been submitted to the Department of Health and Environmental Control for an addition of approximately 9,365 square feet. This expanded space will provide improved workflow for staff and patients, new exam and treatment rooms including designated triage and trauma rooms, as well as staff support spaces.

A new entrance for walk-in patients will separate them from those arriving by ambulance. A new family waiting area designed for improved privacy and safety will also be included in the expansion. In addition, a dedicated site for a helipad for trauma patient transport is planned as well as minor modifications to existing Emergency Department exam rooms and support functions.

As soon as approval is received from DHEC, the project will begin and is estimated to take 220 days to complete. We look forward to improving these facilities in Dillon to better meet the needs of our patients.

On Monday evening I attended the first Medical Staff meeting of 2010 for McLeod Regional Medical Center. It was the first meeting for Dr. Bill Boulware to preside as the new Chief of Staff. Serving with him for two years, 2010 and 2011, are Dr. Dale Lusk as Vice Chief, and Dr. Andy Rhea, as Secretary. We deeply appreciate the time our physician leaders give toward supporting the medical staff and the organization. My observation, in the years I have been with McLeod, is that we have been blessed with good, strong medical staff leadership. I believe these leaders will continue that tradition of excellence.

Dr. Andrew Rhea, Dr. Dale Lusk, and Dr. William Boulware

Since you may not be aware of the work that goes on at the medical staff level, let me give you a glimpse into Monday night’s meeting.

At five o’clock on Monday afternoon, the Medical Executive Committee (MEC) met in the Board Room to hear committee and department reports. The MEC also had a discussion on medication reconciliation and medical record completion. Medication Reconciliation is the process of reviewing all of the medications a patient is taking upon admission to the hospital, when they are transferred within the hospital, as well as when they are discharged home. Since a patient’s medications may change many times during a single hospitalization, the reconciliation process makes it safer for the patient by helping to prevent unintended medication changes and by providing a current list of medications for the patient at discharge.

On Monday night, the physician leaders were considering utilization of the computer system to electronically perform medication reconciliation. This electronic review process allows the physician to review and continue a patient’s medications from home, change or order new medications and decide which medications the patient should take once they are discharged. Electronic prescriptions and a current medication list are also available for the patient at discharge. A successful pilot project has occurred at McLeod Dillon and another is being planned for McLeod Darlington. The medical staff in Florence will monitor the results of this second pilot project and make recommendations about the system’s use in Florence.

The Medical Executive Committee adjourned the meeting in order to join the full medical staff meeting which was underway in the McLeod Pavilion Auditorium. The full medical staff was briefed on the main points of discussion in the MEC meeting. The minutes were reviewed by Dr. Andy Rhea. For the medical staff program on Monday night, Dr. Boulware introduced Marie Segars, Sr. Vice President and Administrator for McLeod Regional Medical Center. Marie presented an update on the master facility plan for the Florence campus, highlighting the immediate plans for 2010. Since 2007, several teams in cardiology, cancer have been working on needs for the McLeod campus and the results of this research were presented by Marie to the medical staff. In addition to power point slides on the proposed facility changes that will take place over the next several years, the room was full of models and blueprints. Physicians had the opportunity to ask questions and walk around the auditorium to see the models and plans on display. The informal discussion revealed several good observations and options to consider for the master facility plan. The meeting adjourned at 7:10 PM.

These meetings take place each month at all three hospitals. We appreciate the active leadership of our physicians as we seek to improve services for patients.